Heart Risk for Younger Women May Be Lowered with Estrogen
Women in their 50s who take estrogen therapy have lower levels of dangerous calcium deposits in their arteries, suggesting they are at reduced heart disease risk, says a new report.
The study authors, reporting in the New England Journal of Medicine, say the results should reassure younger women who use supplemental estrogen to lessen their menopausal symptoms.
They also caution that it should not be seen as a license to use hormone-replacement therapy (HRT) to prevent heart disease.
The findings should "provide reassurance to younger women who are wrestling with the decision, that hormones are unlikely to have an adverse effect on the heart and may even slow the early stages of plaque build-up," says lead researcher Dr. JoAnn Manson, at Brigham and Women's Hospital in Boston.
However, "the study should not be interpreted to mean that women should take estrogen to prevent cardiovascular disease. There are other risks to hormones, including the risk of blood clots in the legs," notes Dr. Manson.
Dr. Suzanne Steinbaum, at Lenox Hill Hospital in New York City, says the study becomes very important but not for prevention and not for treatment of heart disease, but to alleviate the fears of people in the context of developing heart disease if they are taking HRT.
"Women aged 50 to 59 who are having [menopausal] symptoms can really say, 'I can take HRT without getting heart disease,' " says Dr. Steinbaum.
Statements from numerous organizations echoed those sentiments.
"The results... are very encouraging," states the International Menopause Society.
The group also notes that the CT scans used in the trial were performed at a mean age of just under 65 years of age. That "suggests a new 'safety margin' for age and duration of estrogen therapy, as women can be reassured that estrogen therapy is cardioprotective at least until age 65,” states the Society.
The findings "provide additional reassurance to women in their fifties that there is little risk in beginning estrogen therapy to treat menopausal symptoms such as hot flashes, night sweats, and discomfort with intercourse," says Dr. Robert W. Rebar, executive director of the American Society for Reproductive Medicine. "In fact, estrogen may actually protect against development of heart disease."
The new study is based on data from the landmark Women's Health Initiative (WHI) trial. It is the first randomized trial to examine the relationship between estrogen therapy and coronary artery calcium in this age group.
The original WHI was halted when researchers found an increased risk of adverse events which, depending on whether the woman was taking estrogen alone or estrogen plus progestin, included heart attack, stroke, breast cancer, and blood clots. Dr. Manson was one of the principal investigators on the WHI trial.
"That study enrolled women aged about 50 to 79,” says Farida Sohrabji, Ph.D., at Texas A&M Health Science Center in College Station, Tex.
“Many had been postmenopausal for decades and some had never had symptoms such as hot flashes and sleepless nights,” she notes. “Collectively, it was bad news."
When older and younger women in the study were looked at together, "women who took hormones had a higher incidence of cardiovascular disease," says Dr. Sohrabji. "But if you looked very carefully even at that old data, in the youngest group - 50 to 59 - there was a hint that it wasn't really bad for the heart."
The new trial focused on younger women - specifically, 1,064 women aged 50 to 59 who had undergone a hysterectomy and who were randomly selected to receive either estrogen or a placebo.
The treatment lasted a mean of 7.4 years and there was an additional follow-up of 1.3 years.
Women receiving estrogen were 30 percent to 40 percent less likely to have severe coronary artery calcium than women on the placebo, notes Dr. Manson's team.
Women who had at least 80 percent adherence to the medication had a 60 percent lower risk of severe coronary calcium, as well.
"The data are very convincing,” says Dr. Sohrabji. ”They show that the women who took estrogen replacement therapy clearly have much smaller plaque than women who took a placebo. But early postmenopausal and late postmenopausal women need to be treated as different groups. That's really critical."
And the use of hormones does need to be restricted to the relief of menopausal symptoms, not as a means of preventing heart disease, she adds.
"It is showing that women who do take [estrogen] have a decreased incidence of heart disease," says Dr. Steinbaum. "Maybe at some point down the line we might say it's OK for [heart disease] prevention but right now they can't say that. Don't take [hormones] for prevention."
Always consult your physician for more information.
|
It is a myth that heart disease is a man's disease.
In fact, one in 8 women aged 45 to 64 has heart disease. One in four women over the age of 65 has heart disease.
Currently, 7.2 million women have heart disease, states the American Heart Association (AHA).
Coronary heart disease is the single largest cause of death for females in the US.
Almost 16 percent of girls ages six to 19 are overweight, which is a risk factor for heart disease.
About 25 percent of girls in grades nine through 12 report using tobacco, which is a risk factor for heart disease.
At menopause, a woman's heart disease risk starts to increase significantly. Each year, about 88,000 women ages 45 to 64 have a heart attack.
Beginning at age 45, more women than men have elevated cholesterol.
Each year, about 372,000 women age 65 and older have a heart attack. About 21 million women age 60 and older have high blood pressure.
The average age for women to have a first heart attack is about 70, and women are more likely than men to die within a few weeks of a heart attack.
About 35 percent of women who have had a heart attack will have another within six years. A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by blocked blood flow to the heart muscle.
The blockage is often a result of atherosclerosis - a buildup of plaque, known as cholesterol, other fatty substances, and a blood clot.
Plaque inhibits and obstructs the flow of blood and oxygen to the heart, thus reducing the flow to the rest of the body.
If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer severe and devastating damage and die.
The result is damage or death to the area of the heart that became affected by reduced blood supply.
Symptoms include:
- severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
- pain or discomfort that spreads to the shoulders, neck, arms, or jaw
- chest pain that increases in intensity
- chest pain that is not relieved by rest or by taking nitroglycerin
- chest pain that occurs with sweating, cool, clammy skin, and/or paleness
- shortness of breath
- nausea or vomiting
- dizziness or fainting
Always consult your physician for more information.
|
